PROJECT SUMMARY/ABSTRACT Human Papillomavirus (HPV)-associated cancer has been dramatically rising for the last few decades. The development and implementation of HPV vaccination and screening provide the promise of prevention. Primary prevention and advances in genomic prognostication has shifted the landscape of HPV-associated cancers. Efficacious and equitable prevention and treatment efforts for vulnerable groups requires an understanding of geographic, social and molecular determinants of HPV-associated cancers unique to these underserved and understudied populations. The goal of this proposed research proposal is to study how social determinants of health influences and interacts with molecular tumor markers to affect HPV-associated cancers. Dr. Mazul?s career goal is to become an independent researcher who is uniquely positioned to develop, conduct, and communicate research bridging cancer social determinant of health biology with social epidemiology. In the proposed training plan, Dr. Mazul will build upon her cancer epidemiologic skills to develop additional expertise in geospatial analysis and social epidemiologic methods, while expanding her cancer knowledge into HPV- associated cancer biology. Her training will be directly applied to support and advance her career as an independent researcher and the proposed research plan. Geospatial and social epidemiologic methods will be employed to understanding the interaction between social and molecular factors. We will use data from three sources representing national, Missouri statewide and local St. Louis HPV-associated cancer cases to compare the three most common HPV-associated cancers (oropharyngeal, cervical and anal). Three aims will address the overall hypothesis that poor neighborhood-level factors interact with molecular markers and to lead to poor HPV-associated cancer outcomes. Aim 1. Identify nationwide and statewide spatial clusters of HPV-associated cancers using geographic information systems and geospatial modeling. Aim 2: Measure the effect of neighborhood-level social and demographic factors on HPV- associated cancer stage at presentation and survival. Aim 3: Measure the prevalence and prognostic significance of HPV genotype in a demographically and socioeconomically diverse HPV-associated cancer population. Results from this study will provide a more nuanced assessment of the complex social and genomic factors linked with HPV-associated cancer. With this training and experience, Dr. Mazul will be well positioned to launch her independent research career.